Patient Centered Primary Care Home' Is More Than a Catchphrase

Some medical practices around Portland have earned a special designation. And while patients may not be aware that their doctor’s office is actually a Patient Centered Primary Care Home, they may notice extra efforts being made to reach out to them and catch problems early.

At least, that’s the idea behind the Patient Centered Primary Care Program (or PCPCH, which is still a mouthful). The state designated 450 Oregon clinics as PCPCHs since the program started in 2009. The model is seen as a way to better serve a patient population that’s more complex than ever, with more chronic diseases.

PCPCHs are also key to the Coordinated Care Organization’s goals. The CCOs, which deliver health care to Oregon Health Plan members, are trying to steer all 600,000 Medicaid patients into these "homes" (about 70 percent are currently participating).

After writing an initial story about PCPCHs, I spoke to several providers about what the PCPCH designation really means in their day-to-day practice.

Before we get to that, some PCPCH basics: The goal is better coordination among physical and mental health providers and various specialists, along with increased teamwork and an emphasis on prevention and managing chronic conditions. Other hallmarks include improved quality of care, access, case management, tracking and referrals.

Portland’s Northwest Primary Care Group has the highest of three tiers of PCPCH certification. The process led the clinic to ponder, “What should a medical home look like?” said Dr. David McAnulty, medical director at Northwest Primary Care.

“It matches with our vision and puts a framework on it,” McAnulty said. “It made us look at our practice and ask, ‘Should we do more?’”